Provider Demographics
NPI:1194722512
Name:KORNICK, CRAIG ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ALLEN
Last Name:KORNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7207 GOLDEN WINGS ROAD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-2004
Mailing Address - Country:US
Mailing Address - Phone:904-389-1010
Mailing Address - Fax:904-389-1082
Practice Address - Street 1:7207 GOLDEN WINGS ROAD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244
Practice Address - Country:US
Practice Address - Phone:904-389-1010
Practice Address - Fax:904-389-1082
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82614208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5849952001OtherCIGNA
FL217227OtherHEALTHEASE
FL26192880Medicaid
FL3046289OtherAETNA
FL01896OtherBLUE CROSS BLUE SHIELD
FL01896OtherBLUE CROSS BLUE SHIELD
FL01896XMedicare PIN